VNS Health MLTC: Nursing Home Care

Although the health plan does its best to meet the member's needs at home, there may be times when it is more appropriate for them to receive care in a nursing home. Admission to a participating nursing home is made on an individual basis. The decision to receive care in a nursing home must be made by the individual, the provider, the family, and the Care Manager.

There are two types of nursing home stays: short-term for respite or rehabilitation and long-term for ongoing care.

• Subacute rehabilitation (rehab)

  • A stay in a skilled nursing facility (SNF) where you or your loved one is monitored and has access to a wide range of therapies and clinical education to aid in their recovery.

  • The goal of subacute rehab is to restore you or your loved one's physical abilities and return them home, or to a lower level of care, as quickly as possible.

• Respite care

  • A stay in a nursing facility to provide relief to family caregivers from caregiving responsibilities.

  • Typically limited to 6 weeks per year for most health plans.

• Custodial care

  • You or your loved one transitions to a nursing home with the intention that it will become their permanent residence.

One of the ways the health plan can be helpful is to check eligibility for institutional care under Medicaid. If current Medicaid eligibility only allows the member to receive community services, you may be asked to complete an application for institutional Medicaid. The application includes a review of financial assets and income for the past five years.

Staff from Member Services and the Eligibility Unit will help with this process. This is important because it can affect you or your loved one's ability to receive care in a nursing home.